Repeated use of albuterol inhaler as a potential cause of Takotsubo cardiomyopathy

PATIENT: Female, 78 FINAL DIAGNOSIS: Takotsubo cardiomyopathy Symptoms: Chest discomfort, chest pain, dyspnea, short of breath Medication: - Clinical Procedure: - Specialty: Cardiology. OBJECTIVE: Unusual or unexpected effect of treatment. BACKGROUND: Takotsubo cardiomyopathy is an increasingly recognized cardiac condition that usually results from an acute stressor. Some medications are becoming recognized as possible stressors. Albuterol is widely used in general medicine. We report an unusual link between Takotsubo cardiomyopathy and albuterol. CASE REPORT: A 78-year-old woman presented to our emergency department for chest pain of 2-day duration. The patient had been taking albuterol inhaler therapy for worsening shortness of breath followed by chest pain. Her albuterol use was excessive. There were no other acute stressors. The electrocardiogram showed ST-elevations in the anterior and inferior leads. Emergent coronary angiography showed noncritical coronary artery disease and left ventriculography showed apical ballooning. CONCLUSIONS: When patients taking albuterol present with acute chest pain in the absence of other etiologies, beta-agonist-induced Takotsubo cardiomyopathy should be considered.